Tennessee lawmakers tighten regulations for prescription pain pills

Brenda Roberts sits on the bed of her son Mark in the basement of her home. Mark Roberts died in 2011 from an overdose of pain pills.

After watching her son fight a crack addiction for 23 years, Brenda Roberts had long feared he would die from his battle with drugs.

"I always thought he'd die in a drug deal gone bad, or that cocaine would take him," Roberts said.

On Oct. 11, Roberts' darkest premonitions came true when her son Mark Roberts died after an overdose at the age of 42. But Mark didn't die on a street corner, and it wasn't from crack.

Mark Roberts died on his mother's couch inside her Old Hickory home after he took drugs prescribed for him by a local pain clinic and given to him at a nearby pharmacy. Roberts said coping with her son's death has been more painful because it was medical professionals, not drug dealers, who doled out the narcotics and antidepressants that led to his overdose.

In Tennessee, the state's pain pill epidemic can be measured in alarming statistics about the rise and frequency of prescriptions. But families count a different toll: loved ones dead from overdoses or in a downward spiral of addiction to such drugs as hydrocodone and oxycodone.

Lawmakers and state officials are hurrying to address the problem with expanded regulations, including a new proposal from Gov. Bill Haslam that would require doctors and pharmacists to consult a controlled substance database before writing or dispensing such prescriptions.

But those efforts did not take root in time to save Mark Roberts and thousands of others. The death rate for drug overdoses has nearly tripled to 16 deaths per 100,000 people in Tennessee since 1999, according to data from the state Division of Health Statistics.

"It's very frustrating and very painful looking back on everything," Brenda Roberts said.

The conundrum facing law enforcement who have been dealing with pain pill abuse for nearly a decade is that those taking the drugs aren't the typical abusers. The drugs aren't being dealt on the street, and the users have prescriptions written by doctors, often in pain clinics, and distributed by pharmacists.

On the Internet, those seeking a quick and easy source of pain medications often trade tips and locations of cooperative doctors. On one local blog, a posting asks for advice on a good place to get "roxys," the street name for Roxycodone, a fast-acting form of oxycodone.

"At a state level we're finding it to be extremely difficult to do anything when these folks are carrying their own prescription meds," Tennessee Highway Patrol Sgt. Greg Roberts said.

Old habits reappeared

After he injured his back in an automobile accident in November 2010, Mark Roberts sought help from a pain clinic. A pain clinic is defined by state law as a privately owned facility where more than half the patients are prescribed pain management narcotics for durations of more than 90 days.

Even though Mark had a history of drug abuse, his mother said he had stayed away from crack for more than a year before he was prescribed oxycodone and morphine at the clinic.

By July 2011, Mark suffered an overdose. His mother found him collapsed on the couch and rushed him to an emergency room. Despite this incident, Mark's medical records show that doctors continued to prescribe 30-milligram oxycodone and morphine pills in addition to the antidepressants he was prescribed by his psychiatrist.

"I just prayed a lot and talked to him, and begged and pleaded for him to take the medicine right. But you cannot make a 42-year-old man do something they don't want to do," Brenda Roberts said.

Officials face dilemma

The circumstances surrounding Mark Roberts' death outline the dilemma facing state officials as they consider more regulations for the burgeoning pain management industry: A growing number of Americans are legitimately suffering from long-term battles with pain. But as more people are prescribed powerful painkillers, abuse of that medication has become America's fastest-growing drug problem.

From 1997 to 2007, per-person annual use of prescription opioids in the U.S. increased from 74 milligrams to 369 milligrams, an increase of 402 percent, according to the National Office of Drug Control Policy.

According to the National Institute on Drug Abuse, an estimated 52 million people use prescription painkillers for nonmedical reasons at least once in their lifetimes.

A 2010 report by the Centers for Disease Control and Prevention found that Tennessee ranked No. 8 nationally in drug overdose deaths.

State Sen. Ken Yager, R-Harriman, said he believes new state regulations will help reduce those deaths.

Recognizing the proliferation of unscrupulous doctors operating so-called pill mills -- pain clinics where copious amounts of narcotics frequently are prescribed -- especially in East Tennessee, the Legislature last year unanimously passed Yager's bill that imposed unprecedented regulations on pain management clinics.

The new regulations, which took effect Jan. 1, require pain clinics to register with the Tennessee Department of Health, outlaw cash payments for treatment -- a trademark of pill mills -- and require licensed physicians to be present in the clinics at least 20 percent of the time.

Through Friday, 147 pain clinics had registered with the Department of Health. Applications by 19 other clinics were rejected, either because a doctor did not own the clinic or because the medical director previously had been disciplined for inappropriately prescribing a controlled substance.

Any medical professional found to violate the new regulations, or found working at a clinic that doesn't register with the state, could be fined or have his license suspended.

"I've been in regular contact with the Health Department, and I believe the new regs are already working," Yager said.

Loophole targeted

With the support of Haslam's administration, Yager is looking to close the remaining loophole that enables patients with pain pill addictions to shop for doctors who will give them access to prescription opioids such as oxycodone, Vicodin and morphine.

His proposal would require doctors to check a statewide controlled substance database each time they write a prescription for a new patient with a pain problem. The database requires doctors to enter such basic patient information as the drugs prescribed and the dosages within 24 hours.

Additionally, Yager said the new bill would require pain clinic doctors, but not other practitioners, to enter a reason in the database for writing a prescription for a controlled substance.

The hope is that good doctors and pharmacists will catch patients shopping for providers who are lenient in their prescription practices.

Mark Roberts' autopsy report revealed he died from acute combined drug toxicity from oxycontin, oxycodone, morphine, and antidepressants in his system. His psychiatrist prescribed some of the antidepressants, according to medical records reviewed by The Tennessean.

"I believe it very well might have saved his life if they looked at that database before they wrote him" prescriptions, Brenda Roberts said.

Chronic pain is problem

Dr. Marc Huntoon, chief of Pain Medicine at Vanderbilt University Medical Center and a professor of anesthesiology at Vanderbilt University, said legitimate pain practitioners won't have a problem with the new regulations because they are helpful tools to guide treatment.

But Huntoon said it also is important to recognize chronic pain as a growing problem in the United States.

A study released this month in The New England Journal of Medicine said 116 million Americans battle pain of some sort on a daily basis, and doctors with a subspecialty in pain management believe chronic pain should be categorized as its own disease.

Patients seek help with pain management for a variety of reasons, such as coping with cancer treatment or recovering from a back injury.

"It's a shame, because patients have what many of us in the field believe is a new disease entity, just like obesity is a disease or diabetes is a disease," Huntoon said.